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Pediatric Ear Infections and Ear Tubes
Effectiveness of Pressure Equalization Tubes
Reduce number and severity of repeated middle ear infections (by at least 50%).
PE tubes reduce the need for and number of antibiotics. Resistance to antibiotics affects the entire body so that an infection involving the sinuses, bladder, lungs, etc., are also resistant to antibiotics. If we can eliminate the need for antibiotics for several months, the resistance may go away. Many times ear infections in a child with PE tubes can be treated with ear drops alone, which limits resistance problems. Drops can be started by the parents without seeing the doctor.
PE tubes maximize hearing even with an ear infection.
Easier to diagnose ear infections- you will see drainage from the ear.
Drawbacks/Risks with PE tubes
Requires surgery- surgery typically takes 15 minutes and requires a general anesthetic. We use an operating microscope to make a pin-sized hole in the eardrum. If there is fluid or infection, we then remove the fluid and place a tube in the eardrum. The removal of the fluid will improve the hearing immediately and remove the focus of infection. Most children recover from surgery within a few hours. Pain is usually not severe: Tylenol® is usually sufficient and often not even used.
Requires general anesthetic- if there is a lot of anxiety or a fear of separation anxiety, you and the anesthesiologist may decide to use a preoperative sedative. It helps the child calm down, and become drowsy or forgetful. It does prolong the wakeup and is not always used. The anesthesiologist administers inhaled medication through a mask. We perform over one hundred PE tube procedures per year. The children typically recover from the anesthetic that day and experience minimal postoperative discomfort.
Tympanic membrane (ear drum) - there is a 2-3% risk of a persistent hole in the ear drum following the extrusion of the PE tube (tubes last for 12-18 months on average). However, untreated ear infections can also cause a persistent hole in the ear drum. The hole will usually close within a few weeks. If the hole does not close, we usually wait until the child no longer is at risk for ear infections, then close the hole surgically (tympanoplasty/myringoplasty). Successful closure is over 90%.
Cholesteatoma - this very rare condition (much less than 1%) develops when skin becomes trapped behind the ear drum. The skin collection grows and can destroy surrounding tissue such as the hearing bones. Although this can happen as a result of tube placement, it is more likely to happen as a result of untreated chronic ear infections. Early detection is very important for treatment.
Water precautions - there is theoretical risk of an ear infection from water entering through the tube. However, studies have shown minimal risk of infection from water exposure. We generally recommend no special precautions for exposure to “clean” water (shower, bath, swimming pools). Older children exposed to “dirty” water (lake, river, ocean) may benefit from ear plugs or bands.
Follow-up
We generally would like to see your child 1-2 weeks following surgery to check the ears and retest the hearing. If your child is doing well, we then recommend rechecks every six months until the tubes have come out. Routine and occasional ear infections can be treated with ear drops. Call the office if ear drainage occurs, and we will call in a prescription without you having to make an office visit. If your child is developing repeated or persistent ear infections, call and schedule an appointment with your doctor.
A video (approx. 8 minutes) describing ear tube placement is available for viewing in our office library. Inform our office staff if you are interested in viewing it.
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